Authorization Specialist- Team Lead

The Authorization Specialist - Team Lead (“Team Lead”) serves as an administrative support in the back office of the organization, as well as support for current Authorization Specialists. The Team Lead assists in eligibility, verifications and authorization procedures, HCHB updates, monitoring, as well as supporting our Operational partners via telephone, e-mail, and teams. The Team Lead has an increased responsibility to act as the ‘Subject Matter Expert’ for all questions related to authorization processes and maintain fluid communication with branch leadership to ensure smooth & quick processing of eligibility, verifications, and authorizations for all patients. The goal is to support Operations and ensure the process is seamless for the patient with no disruption/delay in care. Building Clinical Excellence Through Empowered Employees! What Can Traditions Health Offer? PHENOMENAL PTO- -Starting Day 1!!! Competitive Salary Supportive Leadership Career Growth opportunities Training Environment Work/Life Balance MDLive: 24/7/365 access to doctors 401K and HSA with MATCH Job Qualifications Education: High school diploma or equivalent Some college, or higher education is preferred Experience: 2 years or more in a healthcare or administrative role; Prior authorization experience preferred Knowledge and Skills: Must be organized, detail-oriented, and possess effective communication skills. Must be capable of prioritizing and handing multiple tasks of critical important and function well in an atmosphere of stress. Possess knowledge of insurance payors within Home Health or Hospice Must provide excellent customer service to clients and maintain professionalism. Knowledge of the EMR Home Care Home Base strongly desired. Knowledge of Authorization platforms such as Availity, Waystar, Carelon, NaviHealth, eServices etc.- preferred. Ability to communicate with multiple agency staff effectively and clearly, while executing daily tasks. Must maintain the privacy and confidentiality of all staff and clients in line with HIPAA standards. Transportation: Reliable transportation. Valid and current auto insurance. Travel: 10% Essential Functions: Coordinate the routine office environment and ensure adequate two-way communication under the guidance of the Director of Revenue Optimization Report and monitor compliance of policies and procedures according to Medicare/Insurance guidelines and Company policies. Quickly and accurately process patient eligibility, insurance verifications, and prior authorizations for home health or hospice. Communicate with branch staff regarding eligibility, insurance, and authorization questions regarding patients. Communicate with branch office staff regarding partial/denied authorizations. Review and process Eligibility and Auth Coordinator/Office Coordinator/Scheduler workflow each day, accurately and timely. Assist with training of all new Authorization Specialists Audit all new Authorization Specialists and existing specialists on a regular cadence Assist with scheduling to ensure adequate coverage for timely workflow to ensure patient continuity of care. Provide input for associate reviews. Follows all procedures as outlined in Standard Operating Procedures (SOP). Works within the policies as defined by Traditions Health. Ensuring phones are answered and calls are directed professionally and efficiently to appropriate staff while maintaining a pleasant and helpful demeanor. Eligibility and Authorizations- Coordinate and communicate all aspects and processes of new admissions/Reauthorizations/Additional authorizations in a timely manner. Verifies Insurance benefits and documents in coordination notes section of HCHB. Additionally, verify initial insurance coverage; enters patient information regarding authorizations/coverage approval. Follow-up coordination for all referrals and maintain detailed comprehensive documentation in EMR. Follow-up customer service calls for branch and patients Monitor workflow and Insufficient Authorizations reporting to ensure patient has adequate authorization for care. Provide effective communication to team members, Operational partners and maintains confidentiality. Demonstrate commitment, professional growth, and competency. Understands and exhibits Traditions Health Care Mission Statement and Care Core Values. Provide computer support and data entry. Perform other duties as assigned. Equal Employment Opportunity: Traditions Health is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination of any kind based on race, color, sexual orientation, national origin, disability, genetic information, pregnancy or any other legally protected characteristic. Traditions Health is a rapidly growing, innovative provider in home health care and hospice. It is our mission to promote health and independence in the patients we serve, to attract and retain exceptional healthcare professionals and to conduct our business with compassion and integrity. We believe that our core values of Integrity, Compassion, Patient Satisfaction, Team Attitude, Compliance, Professionalism, and Commitment are the foundation of our success.